Several years ago, a large provider suffered a computer system crash. Despite having devoted IT staff and internal policies, it was discovered that the practice’s back-up had not been performed in several months. We are not “tecchie” so we can’t tell you exactly what contributed to the system failure, but over time, it became clear that this seemingly small issue had large repercussions. The practice lost all data for approximately a three-month period.
Operational interruption – When the system went down, the practice was paralyzed. Imagine something as basic as not having the day’s schedule for all your providers and being ‘surprised’ by every patient who comes in to be seen! This issue plagued the practice for several months until the patients with follow-up appointments scheduled during the unrecoverable period were seen and new follow- up appointments were scheduled. Fortunately, patients were understanding about the “temporary computer glitch” and seeming chaos reigning in the office.
During the initial days, eligibility could not be checked without asking the patient for a copy of the insurance card and manually checking at the time of the appointment; the practice decided to temporarily forego eligibility checking. Consequently, co-payments were not collected and billers were tasked with sending statements to collect them. A system to notify the MA of the patient’s readiness had to be re-created because they usually relied on the EMR for notification, and providers resorted to paper visit notes. But first, a template had to be created.
Pending referrals during the glitch period could not be completed and the practice had no knowledge of them. For a few weeks, the referral department was inundated with patient calls regarding referrals and the staff needed to work quickly to resolve the issues and satisfy the patients. These issues were just the tip if the iceberg.
Liability concerns – Providers, of course, wanted to assure quality patient care and minimize liability in seeing patients without a medical record; basic information, such as medications, chronic conditions and details from the last visit, were verified with the patient. There was also a blackout on any documents uploaded to the EMR during the glitch, so MAs had to verify if the patient had seen any specialists recently or had any recent hospitalizations, and scramble to obtain the records.
Billing & revenue issues – When it was revealed that a few months’ worth of information was unrecoverable, billers could not bill for the preceding few days’ visits because there were no progress notes; the inability to bill resulted in credit balances for those patients who had paid their co-payments. Similarly, they had no ability to refute denied claims or to defend themselves in a payment audit because the progress note was irretrievable.
Like peeling an onion, we could go on listing the challenges that resulted from this issue, but the point of this message is to spotlight the importance of verification. As managers, we cannot blindly trust vendors and employees to whom we delegate certain functions without verifying that the work is being done. In the case of IT, this means assuring that your vendor is performing back-ups according to the schedule you established and that the backed-up information is accessible and complete.
As we slide into the 2021 hurricane season, this is a good time to meet with your IT staff and review the issue of back-ups. When and how is information backed up? What information is backed up? When was it last tested? What is the vendor’s plan for disasters and recovery? Don’t just read a vendor’s report or disaster recovery policy; dialogue with the representative until you’re satisfied that your practice’s information is protected. And then verify that it is. Not only is this an issue with operational and financial ramifications, but legal and HIPAA concerns as well.
Coleman Consulting Group, Inc.